Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
J Cardiol. 2012 Oct;60(4):252-6. doi: 10.1016/j.jjcc.2012.06.010. Epub 2012 Jul 25.
We aimed to evaluate acute hemodynamic effects and safety of landiolol in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI).
Beta-blockers have been proven to be effective for the treatment of ischemic heart disease in both the acute and chronic phases. Landiolol, an ultra-short-acting and highly cardioselective beta-1 blocker, has become available in Japan. In the clinical setting, the hemodynamic response to landiolol administration remains unclear in patients presenting with ACS.
From August 2007 to April 2008, landiolol was administered intravenously immediately before reperfusion procedure in 22 consecutive ACS patients (mean age, 63±9 years; 15 men) with a heart rate (HR) of ≥70 beats/min. The initial intravenous administration dose of landiolol was 20 μg/kg/min in all patients. The maintenance dose was titrated with the aim of reducing HR by 15%. Acute hemodynamic data including HR and systolic and diastolic blood pressure were serially evaluated.
HR dropped significantly (from 87±11 to 72±8beats/min, p<0.001) 20 min after landiolol initiation. However, systolic and diastolic pressure remained unchanged during administration of landiolol. Although landiolol was discontinued in 2 patients because of sinus bradycardia, no serious complications such as advanced degree atrioventricular block, requiring temporary cardiac pacing, severe hypotension, cardiogenic shock, or deterioration of heart failure were observed in the patients receiving landiolol.
Landiolol was safe and effective in reducing oxygen demand of the ischemic heart by reducing only HR without lowering blood pressure in patients with ACS undergoing PCI.
我们旨在评估急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）中应用拉地洛尔的急性血液动力学效应和安全性。
β受体阻滞剂已被证明在缺血性心脏病的急性期和慢性期均有效。拉地洛尔是一种超短效、高度心脏选择性的β1受体阻滞剂，已在日本上市。在临床环境中，ACS 患者应用拉地洛尔后的血液动力学反应尚不清楚。
2007 年 8 月至 2008 年 4 月，22 例连续 ACS 患者（平均年龄 63±9 岁；15 名男性）在 HR≥70 次/分钟时于再灌注前即刻静脉内给予拉地洛尔。所有患者初始静脉内给药剂量为 20μg/kg/min。维持剂量滴定以 HR 降低 15%为目标。连续评估急性血液动力学数据，包括 HR 及收缩压和舒张压。
拉地洛尔起始后 20min HR 显著下降（从 87±11 次/分钟降至 72±8 次/分钟，p<0.001）。然而，拉地洛尔给药期间收缩压和舒张压保持不变。虽然 2 例患者因窦性心动过缓而停用拉地洛尔，但接受拉地洛尔治疗的患者中未观察到严重并发症，如高度房室传导阻滞，需要临时心脏起搏、严重低血压、心源性休克或心力衰竭恶化。
在接受 PCI 的 ACS 患者中，拉地洛尔通过仅降低 HR 而不降低血压，降低缺血性心脏的氧需求，是安全有效的。
